{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:58:32Z","timestamp":1773795512629,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In infectious meningitis, pathogens preferentially attack the leptomeninges (pia mater and arachnoid) rather than the pachymeninges (dura mater). This study aims to provide ultra\u2010anatomical insights from our extensive collection of electron microscopy images and propose mechanisms, highlighting structures that favor the introduction, adherence, colonization, and proliferation of microorganisms leading to spinal meningitis. Over several years, we analyzed an extensive collection of transmission and scanning electron microscopy images of human spinal meninges captured in our laboratories. Upon examining 378 of those images, we identified potential sites for the iatrogenic or hematogenic introduction and adherence of microorganisms, as well as sites for their colonization and proliferation. These included the outer surface of the spinal dural sac, structures within the epidural space, and the spinal dural sac itself, which comprises compact dura mater with interwoven collagen fibers and tightly bound arachnoid cells. Also, the subdural (extra\u2010arachnoid) compartment, consisting of fragile neurothelial cells prone to rupture under force, formed an acquired spinal subdural space, a new subarachnoid compartment, limited by arachnoid trabeculae, that surrounded the nerve roots and spinal cord and the pia mater. Macrophages, fibroblasts, mast cells, and plasma cells were also observed within the dura mater, arachnoid layer, arachnoid trabeculae, and pia mater. These images illustrate how the characteristics of the meningeal layers could contribute to bacterial adhesion and proliferation at various locations, inducing selective inflammation during (iatrogenic) spinal meningitis. In addition, the images help to explain why magnetic resonance imaging enhancement appears preferentially at specific sites.<\/jats:p>","DOI":"10.1002\/ca.24228","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T02:45:04Z","timestamp":1726713904000},"page":"269-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Infectious meningitis. Why are the leptomeninges preferentially involved? Electron microscopic insights"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-1214","authenticated-orcid":false,"given":"Andr\u00e9 P.","family":"Boezaart","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"Lumina Health  Surrey UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-1176","authenticated-orcid":false,"given":"Anna","family":"Server","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Hospital Universitari Vall d'Hebron  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-1047","authenticated-orcid":false,"given":"Richard Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Anatomical Sciences St. George's University  St. George's West Indies"},{"name":"Department of Structural and Cellular Biology Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System  Louisiana USA"},{"name":"Department of Neurology Tulane University School of Medicine  Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3265-2778","authenticated-orcid":false,"given":"Ana","family":"Carrera","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Anatom\u00eda Cl\u00ednica, Embriolog\u00eda y Neurociencias (NEOMA), Unidad de Anatom\u00eda Humana, Facultad de Medicina Universidad de Girona  Girona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2664-2277","authenticated-orcid":false,"given":"Francisco","family":"Reina","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Anatom\u00eda Cl\u00ednica, Embriolog\u00eda y Neurociencias (NEOMA), Unidad de Anatom\u00eda Humana, Facultad de Medicina Universidad de Girona  Girona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":false,"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"CEU\u2010Escuela Universitaria de Medicina San Pablo, Madrid, and Department of Anesthesiology Hospital Universitario Madrid\u2010Montepr\u00edncipe  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200608000-00022"},{"key":"e_1_2_6_3_1","first-page":"65","article-title":"Bacterial meningitis after intrapartum spinal anesthesia\u2014New York and Ohio, 2008\u20132009","volume":"59","author":"Centers for Disease Control and Prevention (CDC)","year":"2010","journal-title":"The Morbidity and Mortality Weekly Report"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen360"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2014.03.004"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2004.01.019"},{"key":"e_1_2_6_7_1","first-page":"396","volume-title":"MR imaging of the spine and spinal cord","author":"Henkes H.","year":"2004"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-49386-2_9"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23849"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199812000-00041"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/66.3.383"},{"key":"e_1_2_6_12_1","unstructured":"Hani M. 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